A frenotomy or frenectomy is a procedure that consists of releasing the frenum under the tongue or upper lip to allow for better range of motion. Children may be born with a combination of conditions called a tongue-tie (ankyloglossia) and/or a lip-tie causing restrictions in movement that can cause difficulty with breastfeeding, and in some instances, other health problems like dental decay or spacing, speech and airway difficulties, and digestive issues. These issues can generally be corrected by a simple procedure done with our soft tissue laser.
LASER FRENECTOMY – HOW DOES IT WORK?
A soft tissue laser does NOT cut, it is more a “vaporization” of tissue that occurs with light energy. There is very little discomfort with the laser. Some babies and children sleep through the procedure. There is almost no bleeding from the laser procedure. Lasers sterilize at touch therefore have less risk of infection. The healing is very quick – a laser stimulates bio-regeneration and healing. The result is beautiful tissue, less chance of relapse.
Our laser protective eyewear
TONGUE-TIE – WHAT DOES IT REALLY MEAN?
Ankyloglossia, or tongue-tie, is the restriction of tongue movement as a result of fusion or adherence of the tongue to the floor of the mouth. A tongue-tie is therefore caused by a frenum that is abnormally short or attached too close to the tip of the tongue.
Normal tongue function is important for multiple reasons. Among the many benefits, normal tongue function will allow a baby to latch adequately and breastfeed efficiently, promote normal speech development, make it possible for a child to self-cleanse the mouth during eating, allow adequate swallowing patterns, allow for proper growth and development, and it makes fun little things like eating ice cream, kissing or sticking your tongue out to catch snowflakes possible.
Challenges that can occur with a tongue-tie:
– Inability to open mouth widely affects speech and eating habits
– Inability to speak clearly when talking fast/loud/soft
– Clicking jaws
– Pain in jaws
– Protrusion of the lower jaws, inferior prognathism
– Effects on social situations, kissing, licking ice cream
– Dental health- a tendency to have inflamed gums, and increased need for periodontal surgery
– Tongue tie in the elderly often makes it difficult to keep a denture in place
Before and After frenectomy (notice closure of the gap between the front teeth)
HOW CAN A LIP-TIE AFFECT MY CHILD?
A lip-tie occurs when the upper lip remains attached to the upper gum. Challenges that can occur in children and infants with moderate to severe lip-ties:
– Spacing between the maxillary central incisors, a large gap can form called a diastema
– Difficulties with brushing and flossing
– Increased risk of dental decay
– Repeated trauma to the maxillary frenum because it is so low and prominent
– Pain with breastfeeding
– Inability to adequately flange the maxillary lip upward during breastfeeding, affecting an infant’s latch and ability to create a good seal
WHY DOES IT HURT WHEN I BREASTFEED MY BABY?
Many mothers are often told, or mistakenly assume, that if they cannot successfully breastfeed, there is something wrong with them. In fact, this is not true. Infants may be born with a combination of limiting conditions called a tongue-tie (ankyloglossia) and/or a lip-tie.
Tongue-ties are normally straight forward to diagnose and fairly easy to treat: the tongue is heart shaped when the baby cries; there is an obviously tight frenulum underneath that runs from the floor of the mouth to an area close to the tip of the tongue. Tongue-ties can vary in severity and can include what we call “posterior tongue-tie” which is a lot more difficult to diagnose and recognize. The frenulum looks like it is non-existent so the first instinct is to believe that tongue-tie cannot be the issue. The tongue looks squared off with the floor of the mouth webbing/tenting the tongue. The edges of the tongue will form a cup when crying as it is unable to elevate. The tongue cannot move side to side but instead twists side to side. The tongue struggles to extend out of the mouth while it’s open but is absolutely incapable of “sticking out” when wide open, which is the ideal position for breastfeeding.
Mothers who try to breastfeed their tongue-tied baby suffer tremendously, both mentally and physically. Not only does she have to re-latch the baby multiple times during a feed and deal with feedings that last sometimes hours, she also experiences damaged nipples, cracks, bruises, and pain during feeds. Her risks of breast infection increases and her milk supply can be greatly reduced due to the lack of stimulation from an inefficient latch.
The babies may be losing weight, get sleepy during feeds (as they work much harder than other babies to stay latched), and become extremely gassy and irritable making the parent’s experience even more frustrating. Lip-tied babies end up with blisters on their lips from trying so hard to stay latched. Babies tend to feed a lot more often because their inefficiency results in less intake of milk so hunger kicks in faster.
WHY HAVE THE TONGUE-TIE and/or LIP-TIES RELEASED FOR MY BABY?
– To help make breastfeeding more successful
– To help relieve the pain of breastfeeding and regain healthy nipples and breasts
– To stimulate milk production by adequate stimulation
– To help achieve satisfactory bonding between a mother and her baby
– To ensure adequate feeding and growth of the baby
– To avoid serious long term issues with palatal development, tooth spacing, dental caries, speech impairments, social stigma
WHAT CAN I EXPECT AFTER THE LASER FRENECTOMY IS DONE?
Breastfeeding immediately after the procedure is fine as breast milk contains amazing healing properties and the simple act of breastfeeding will reassure and soothe the baby.
It is possible that latching will be a struggle at first since we are using a small amount of anesthetic to complete the procedure. The numbness will wear off about 30-45 minutes after the procedure. Do not be alarmed if latching is difficult at first.
Posterior tongue-ties may require a few weeks of practice before seeing the benefits of the frenectomy. We recommend to be thorough with the prescribed post treatment exercises and to work with the lactation consultant and possibly a bodyworker (cranial sacral therapist, pediatric chiropractor, etc.) to increase the chances of success.
Frenectomy/Frenotomy Post Operative Care
Principles of Oral Wound Healing
Post procedure stretches are key to getting an optimum result. The mouth tends to heal so quickly that it may prematurely reattach causing a new limitation and/or the persistence or return of symptoms. Wounds tend to contract towards their center as healing occurs. Also, if you have two raw wound surfaces in the mouth in close proximity, they will reattach. Hence, it is important to keep them stretched open.
Active Wound Management – Stretching Exercises
It is important to remember to stay relaxed, smiling, and positive. You should show your baby or child that not everything is going to be painful, be playful. The exercises are not meant to be forceful or prolonged. Stretching exercises with quick and precise movements are best. A small amount of spotting or bleeding is common while doing the exercises, especially in the first few days.
Please view the following videos for some examples of how to do them.
You may use non-numbing teething gel like Hyland’s Teething Gel, Orajel Naturals (No Benzocaine), Tylenol, Ibruprofen (if 6 months of age or older), Vitamin E Oil, or other homeopathic measures to help with discomfort. Starting a few days after the procedure, the wound(s) will look gooey white and/or yellow in appearance. This is a completely normal inflammatory response. The body’s natural way to make a band-aid.
Upper Lip Stretches
This is the easier of the 2 sites to stretch and if you are doing both lip and tongue, start with the lip. Place your finger under the lip and move it up as high as it will go, until you feel resistance. Then gently sweep from side to side for several seconds. Remember, the goal is to open the opposing surfaces of the lip and gum so they cannot stick together.
Under the Tongue Stretches
Insert both index fingers into the mouth and dive under the tongue and and lift towards the roof of the baby’s mouth. The tongue needs three separate stretching motions:
1. Once you are under the tongue, pick up the posterior part of the tongue as high as it will go towards the palate. Hold it there for 3 seconds, relax, and do it again. The goal is to completely unfold the diamond so that you can visualize the entire diamond. The fold of the diamond across the middle is the first place it will reattach.
2. Place your finger in the middle of the diamond and do a gentle circular stretch for several seconds to dilate or open up the diamond.
Turn your finger sideways and do a rolling pin motion to try and keep the diamond as deep as possible. Start at the fold “center” of the diamond and move to either side of the diamond top and bottom to loosen up the muscles of the tongue and floor of the mouth.
Dr. Rumack and Dr. James Jesse, a well-known specialist in the field of laser frenectomies
Dr. Rumack and Dr. Bobby Ghaheri, an ENT physician and breast feeding medicine specialist
Dr. Rumack and Dr. Larry Kotlow, world-renowned specialist in laser frenectomies, at the International Affiliation of Tongue-tie Professionals meeting